UNOS Liver Distribution Proposal and Webinar

Wednesday, October 25, 2017

Liver distribution proposal and webinar

The committee voted to reject the proposal as it was initially written in the version issued for public comment, then voted to support a revised version based on specific feedback requested during public comment. While certain components were generally supported, the consensus of public input recommended changes to other features.

The committee will bring the compromise proposal to the OPTN/UNOS Board of Directors in December. The revised proposal continues to address the essential elements of the public comment proposal, but with key modifications to some parts of it based on feedback from the community.

In summary, these are the key components of the compromise proposal:

Additional transplant priority (equivalent to 3 MELD or PELD points) would be awarded to liver candidates with a MELD or PELD of at least 15, and who are either within the same donor service area (DSA) as a liver donor or are within 150 nautical miles of the donor hospital but in a different DSA or region.

For the purpose of calculating this additional transplant priority, MELD would not be capped at 40. For example, an adult candidate with a calculated (lab) MELD of 38 would receive a score of 41 for offers within the DSA or circle; one with a calculated MELD of 40 would receive a score of 43 for DSA/circle organ offers.

Adult candidates who have a calculated MELD score of 32 or higher, as well as pediatric candidates younger than age 18 with a MELD or PELD score of 32 or higher, would be prioritized for organ offers within the region plus the circle.

Adult candidates with early hepatic artery thrombosis currently receive a standard MELD exception score of 40, unless they meet specific additional criteria that make them eligible for status 1A. Under the current proposal, these candidates are the only ones who would receive immediate prioritization within the region and circle based on an exception score as opposed to a calculated score. They will retain their exception score of 40 for this purpose.

Livers from deceased donors who are age 70 or older, or who are DCD donors, have a separate allocation that prioritizes the DSA before broader distribution to the region or circle. Livers from donors with these medical characteristics are most often used within close proximity of the donor location, according to the medical judgment of transplant professionals.

Patient Information

The American Society of Transplantation is an organization of professionals dedicated to advancing the field of transplantation and improving patient care by promoting research, education, advocacy, and organ donation.